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    ER Neglect
    Riv3thead posted:
    My sister, whom bless her soul, has just about given up, has been filling me in on her 'ER Visit Nightmares'.

    Let's start with the basics, she is on Pain Management for Nerve Damage in her spine thanks to a flopped Epi with her last child.

    She's had oviran cysts throughout her life, and is,,, fairly overweight, which I doubt helps with the whole, nerve damage thing, extra weight can not be helpful.

    ANYWAY, she;s always avoided the ER, usually because she has her own doctors who know her cases and understand.

    About a year ago she became pregnant again, but there was something wrong, she started bleeding, there was severe abdominal pain. Her doctor, told her to go to the ER straight from her office and get checked out.

    The first ER, told her nothing was wrong, it was normal, she was just pregnant.

    Ok. Things got worse, since the first ER treated her like crap her doctor suggested a different one.

    A few days later - The second ER told her she miscarried because they couldn't find the baby.

    The third ER - two days later when things got worse, said they couldn't find her baby but she was still pregnant and not miscarried, assured her it wasn't ectopic.

    Ok, She made had another appointment with her doctor becuase at this point she was extremely confused and hurting and just battered really as each ER treated her like a drug addict and pretty much ignored what she told them, assuming she was there for drugs.

    Within ten minutes of seeing her normal doctor, her doctor drove her to the ER herself and rushed her into surgery. The pregnancy was ectopic, the tube had burst and her abdomen was filling with blood by this point. She lost the tube and nearly died. Each ER, every single one of them, missed a potentially life threatening, and serious thing and she almost DIED becuase she's on pain management and they couldn't see past it.

    Ok fine. This was just an idea of what she goes through.

    Fast forward to this week.

    She had kidney stones, likely bad cysts on her overies again, and god knows what else (her abdomen is swelling). Her doctor told her to go to the ER if it gets worse before they can get her into a specialist.

    She went to the ER yesterday. A doctor didn't even bother coming in to talk to her. A single nurse came in, took blood, and a few minutes later were practically pushing her out the door saying she probably had a virus, here are some antibiotics. Again, she never asked for pain medication, even though she can barely walk due to the pain.

    Should we be worried this is going to be a repeat of before? Is there anyway she can go to the ER and actually be tested and treated like a human being? D:
    ctbeth responded:
    "saying she probably had a virus, here are some antibiotics"

    Anti-biotics are not for use in viral infection. They are for bacterial infections and will do not good against viruses.

    It sure sounds like your sister should stick with her MDs who know her and stay away from ERs.

    Were you there with her? With abdominal pain, an KUB x-ray is usually standard.

    Her MD needs to either meet her at the ER, so phone in to the RN charge of the ER and give instructions, even FAX your sister's history and last physical.

    An MD, PA, or APRN must evaluate each patient to sign discharge instruction form.

    Perhaps collect all of the documentation and discuss the findings with your sister's primary care MD.

    If she actually was prescribed anti-biotics fro a virus, please have her contact her primary care MD, as she should not be taking anti-biotics if she has a viral thing going on.

    Were you actually in the ER with her?

    After the experience with the ectopic pregnancy, perhaps your sister should have a witness (uhm, a support person, if you catch my drift) with her for ER visits.

    Her primary care MD should have another MD covering him / her if he/ she is unable to attend to patients.

    So, good luck.
    ctbeth responded:
    I'm also wondering why her OB kept sending her to the ER. The OB should have seen your sister soon as possible.

    Why did the OB send her to the ER?

    If the OB send a pregnant person to an ER, which is pretty odd to begin with, then an OB (her own or on-call) should have evaluated her.

    Any MD can admit a patient to the hospital. She should not have had to go through an ER for admission.

    Your question is, "Should we be worried this is going to be a repeat of before? Is there anyway she can go to the ER and actually be tested and treated like a human being?"

    My opinion, and it is only an opinion, is that she should see her own MD and not go to the ER. If her MD suspects that she needs in-patient care, that MD should have her admitted under his/ her care, not send her off to an ER.

    I don't know how far along she was with her pregnancy, but if she had an OB, they can diagnose an ectopic pregnancy very early on.

    That OB should have evaluated her the very day, or next day, after her first ER visit. She should not have been seen by 4 ER visits without having seen her OB.

    Did the MD at the first ER visit not tell her to see her OB the next day?

    If they did not, and she returned to additional ERs thrice more, it is her OB who has failed her, if she actually did see the OB as an emergency appt the next day after the first ER visit.

    How is she now? She's not pregnant again now, is she?

    PLEASE put a call in to her primary care MD. If this MD cannot see her until Monday, and if he/ she recommends going to the ER, insist that the MD who is telling her to go to the ER is there, in person, or has his/ her covering MD there, in person, to evaluate your sister.

    He/ she can then admit her to inpatient care. The ER doc does not have to be involved in the admission.

    Please let us know how this plays out, ok?
    77grace responded:
    HI ,
    I agre with Beth ,altough I am not in the medical feild so I can't go into all tha tI don't understand why she would go an ER agaain after so much trouble!Her Dr. should give very important instructions if he send s her there1
    Best of Luck to Her ,77grace
    _swank_ responded:
    I agree with the other posts. I believe it's her own doctors that failed her. I work in a doctor's office and if someone comes in with abdominal pain or some such we write the orders for an ultrasound or whatever and send them to an imaging center ourselves. If there is something wrong then we send them to the hospital to be admitted, not the ER. If we do send them to the ER we call ahead and also send along records with the patient.
    lorigibs40734 responded:
    I I'm going to have to agree with everyone else here. Unless it was on a weekend, or after hours, your sister should have seen her own doctor.

    However, I really hate it when hospital ER personnel label incoming patients as "pill heads" because they are pain patients, and don't treat them accordingly. Do you live in KY because they do that a lot here! Seems to me they should have, at the very least, done an ultrasound.

    I wouldn't take the antibiotics though. They won't treat a virus, and any self respecting MD, PA, or APRN knows that.
    annette030 responded:
    Your sister needs to take someone with her to document what is said and done, as far as tests go for sure.

    It is illegal for a doctor to prescribe any drugs, even antibiotics to a patient he has not even seen. Antibiotics are not even given for viruses.

    This would not have happened in any ER I have worked as an RN in.

    Best of luck to you and your sister.

    Take care, Annette
    ctbeth replied to annette030's response:
    Three ER visits before her obstetrician evaluated her for an ectopic pregnancy?

    Annette and I are both RNs; the scenario that Riv3 described is particularly bizarre.

    anti-biotics for a viral infection

    OB/ GYN missing an ectopic pregnancy

    Pregnant woman bleeding and no OB consult in ER, no US to confirm or deny spontaneous abortion

    Ob/ GYN driving her to the ER

    Rx being written without MD, PA, APRN assessment

    ER discharging a woman who could, "barely walk" due to pain

    I think the weirdest thing is that a pregnant woman appears X3 at the ER, and was sent home without being evaluated by an OB.

    Pain not being assessed in ER

    There are so many sub-acceptable medical care accusations in this story. If all of this is accurate (was Riv3 there with the sister?), then all of the medical documentation should be evaluated by a medical- legal consult.

    Something is very not right.
    Riv3thead replied to ctbeth's response:
    I agree she shouldn't go to the ER anymore and honestly I have no idea why she keeps going.

    As far as the OB sending her to the ER, if I'm not mistaken, her OB lacked whatever equipment was needed quickly, I'm not entirely sure. I wasn't there, in fact at the time I was halfway across the country, my mother was there however, and I was often on the phone with them while they were moving from doctor to ER and such, since I'm nosy.

    I was not there for the OB thing, I was however there for the more recent. They did not do a scan, they just took blood and the doctor never made an appearance. Not once, just a nurse and she was shoo'd out with a prescription for antibiotics.

    We have documents of everything, including witness, her medical records from all ER visits.

    I would have updated sooner but we had to take her back, again, by ambulance this time, when she fainted and knocked her head.

    She's in a hospital now, admitted, and in a hospital that's a bit of a drive but not one of the ones she'd been seeing that were closer but... well... on the south side which regretfully isn't exactly the highest income area. (By the way, the antibiotics was not what she needed, in fact they seemed appalled she was just given them at all, she does in fact have a viral infection on top of the kidney stones and massive ovarian cysts -suprise suprise-).

    We're going to gather all the documentation like suggested and take it to a consultant, thank you.
    jamasa3 replied to ctbeth's response:
    I agree wholeheartedly with BethCT. It has been my experience that a ruptured ectopic is life threatening, but only once it ruptures, not because it is an ectopic. So many times the office MD's will send a pt in to the ER and tell them to go straight there and get admitted, however, the MD needs to fax orders for admission to registration, not the ER and get a bed for the patient. If the office MD knows what is wrong with the patient why put the patient and the family through all the hoops, truthfully, many times, the MD in the office appears too lax to do their own workup and wants the ER doc to do it for them, then they will come in and admit them. Unfortunately, it isn't the nicest way for a patient or their family to be treated since the office MD actually knows the history of the patient anyway. All of this could have been avoided if the office MD would have communicated with registration, bed control or house supervisor. I am so sorry to hear of such a bad experience. I hope your sister is doing better.
    ctbeth replied to jamasa3's response:
    An obstetrician, or experienced RN, can simply palpate a pregnant woman's abdomen and ascertain is the fundus (top of uterus that is an indication of fetal age) if there is a chance of ectopic pregnancy.

    If the Obstetrician's office does not have an ultra-sound machine, which seems highly unlikely in the 21st century USA, then an ultra-sound should be ordered straight away.

    Sending a pregnant woman to an emergency room rather-than evaluating her- day or night- is just plain old wrong.

    I hope that the originator of the convo will keep us up-dated as this situation progresses.

    Get well soon wishes to your sister.

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